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Studies of infant mortality in both historical and modern populations from around the world have shown that the most important single factor affecting the infant mortality rate (IMR) is the way in which babies are fed. When methods of infant feeding are unsatisfactory or dangerous, mortality is high; when improvements are made in feeding practices, mortality falls, often dramatically, in a short period of time. The degree to which changes in infant feeding alone can affect IMRs depends on other factors in the population concerned, primarily the health and nutritional status of the mother; sanitary conditions both within the household and in the surrounding environment; levels of endemic and epidemic diseases; the degree of wealth, education and sophistication of the population; and, if women are employed outside the home, the provision made for infant feeding and care by the child's family and by society.This article examines infant feeding practices in England during the first two decades of the twentieth century, arguably the most important 20 years in the fall in that nation's IMR between 1870 and 1920. The 1900s and 1910s saw many major changes in the ways in which infants were fed in all sections of society. Instigated by government, local Medical Officers of Health and their staff and voluntary organizations, the effect of the infant welfare movement in England in this period was that infants and their mothers were significantly better fed, cared for and able to resist disease in 1919 than in 1900.

Despite the space devoted to studies of European nurses, wet-nursing in England has received scant attention. This is mainly because in some countries, such as France, wet-nursing was regulated by the state and therefore was documented extensively. Also, France and most other Catholic lands had numerous foundling hospitals for which detailed records, often dating from the Middle Ages, survive. But for England, apart from the archive relating to the country nurses of the London Foundling Hospital (founded 1739), and the few remaining records of the nurses employed by Christ's Hospital in the sixteenth century, the evidence is limited and scattered.' How the trade ofwet-nursing was organized and carried on outside these official institutions has received very little attention. Roger Finlay's study of the demography of London (1580-1650) has demonstrated that infants from wealthier parishes were sent out of London to be nursed in country parishes.2 Dorothy McLaren's detailed study of the Buckinghamshire parish of Chesham (1578-1601) has indicated that women who were nursing London infants may have used wet-nursing as a contraceptive technique once

Medical Officer of Health reports for London boroughs, 1900-19, are analysed to determine the incidence of neonatal breast-feeding, duration of lactation, reasons for early supplementation and premature weaning, and their relationship with infant mortality. In a sample of 222,989 infants, breast-feeding rates were very high. Over 90% were breast-fed in the first month, almost 80% at 3 months, and over 70% at 6 months. The poorest boroughs had the highest rates of neonatal breast-feeding, but also a higher incidence of early supplementation and premature weaning. There was a significant positive correlation between breast-feeding and infant mortality due to poor maternal diet and health, poor nutritional quality of supplementary and substitute foods, and the use of an unhygienic feeding bottle. Energetic campaigns to counteract these problems probably contributed to the fall of infant mortality in this period.

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